Imatinib Mesylate or Observation Only in Treating Patients Who Have Undergone Surgery for Localized Gastrointestinal Stromal Tumor

Study Description

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Brief Summary:

RATIONALE: Imatinib mesylate may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Giving imatinib mesylate after surgery may kill any remaining tumor cells. It is not yet known whether imatinib mesylate is more effective than observation only in treating gastrointestinal stromal tumor.

PURPOSE: This randomized phase III trial is studying imatinib mesylate to see how well it works compared to observation only in treating patients who have undergone surgery for localized gastrointestinal stromal tumor.

Condition or disease	Intervention/treatment	Phase
Gastrointestinal Stromal Tumor	Drug: imatinib mesylate	Phase 3

Detailed Description:

OBJECTIVES:

Primary

• Assess whether there is a difference in overall survival between intermediate and high-risk localized GIST patients undergoing complete surgery alone and those undergoing complete surgery plus adjuvant imatinib mesylate 400 mg daily for two years Secondary
• Assess whether there is a difference in relapse-free survival and relapse-free interval between GIST undergoing complete surgery alone and those undergoing surgery + adjuvant Imatinib mesylate 400 mg daily for two years.
• Determine the safety of this drug in these patients.

OUTLINE: This is a randomized, open-label, multicenter study. Patients are stratified according to participating center, risk category (high vs intermediate), tumor site (gastric vs other), and resection level (R0 vs R1).

• Arm I: Patients receive adjuvant oral imatinib mesylate once daily for 2 years in the absence of disease progression or unacceptable toxicity.
• Arm II: Patients are observed (without receiving further antitumoral therapy) every 3 months for 2 years.

After completion of study treatment, patients in arm I are followed every 3 months for 2 years. All patients are then followed every 4 months for 3 years and at least annually thereafter.

PROJECTED ACCRUAL: A total of 900 patients will be accrued for this study within 3.5 years.

Study Design

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Study Type :	Interventional (Clinical Trial)
Actual Enrollment :	908 participants
Allocation:	Randomized
Intervention Model:	Parallel Assignment
Masking:	None (Open Label)
Primary Purpose:	Treatment
Official Title:	Intermediate and High Risk Localized, Completely Resected, Gastrointestinal Stromal Tumors (GIST) Expressing KIT Receptor: A Controlled Randomized Trial on Adjuvant Imatinib Mesylate (Glivec) Versus No Further Therapy After Complete Surgery
Actual Study Start Date :	December 2004
Actual Primary Completion Date :	October 2008
Actual Study Completion Date :	September 2017

Arms and Interventions

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Arm	Intervention/treatment
Experimental: Imatinib mesylate; 400 mg/day for 2 years	Drug: imatinib mesylate; 400 mg/day for 2 years
No Intervention: Control

Outcome Measures

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Primary Outcome Measures :

1. Overall survival

Secondary Outcome Measures :

1. Relapse-free survival
2. Relapse-free interval
3. Adverse events

Eligibility Criteria

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Ages Eligible for Study:	18 Years to 120 Years (Adult, Older Adult)
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	No

Criteria

DISEASE CHARACTERISTICS:

• Histologically confirmed gastrointestinal stromal tumor

  • Localized disease

• Meets 1 of the following criteria:

  • At high-risk of relapse, defined by 1 of the following criteria:

    • Tumor size > 10 cm
    • Mitotic rate > 10/50 high-power field (HPF)
    • Tumor size > 5 cm AND mitotic rate > 5/50 HPF

  • At intermediate-risk of relapse, defined by 1 of the following criteria:

    • Tumor size < 5 cm AND mitotic rate 6-10/50 HPF
    • Tumor size 5-10 cm AND mitotic rate < 5/50 HPF
• Tumor must stain positive for Kit (CD117) by polyclonal DAKO antibody staining

• Must have undergone complete resection of the primary tumor at least 2 weeks, but no more than 3 months, before study entry

  • Meets criteria for 1 of the following resection levels:

    • R0 (clear margins)

    • R1, defined by 1 of the following criteria:

      • Margins of resection are contaminated by tumor, but no macroscopic tumor is left behind
      • Intraoperative tumor rupture
      • Shelling-out procedure
      • Endoscopic maneuver

  • No residual macroscopic disease after surgery

    • Regional positive lymph nodes allowed provided they have been macroscopically excised

• No distant metastases*, including any of the following:

  • Peritoneal lesion not contiguous to the primary tumor
  • Liver metastases
  • Hemoperitoneal metastases NOTE: *Even if a complete resection (R0) was performed

PATIENT CHARACTERISTICS:

Age

• 18 and over

Performance status

• WHO 0-2

Life expectancy

• Not specified

Hematopoietic

• Absolute neutrophil count ≥ 1,500/mm^3
• Platelet count ≥ 100,000/mm^3
• Hemoglobin ≥ 9 g/dL (transfusions allowed)

Hepatic

• Bilirubin ≤ 1.5 times upper limit of normal (ULN)
• AST or ALT ≤ 2.5 times ULN
• No uncontrolled liver disease
• No chronic viral hepatitis at risk of reactivation

Renal

• Creatinine < 1.5 times ULN
• No uncontrolled chronic renal disease

Cardiovascular

• No New York Heart Association class III-IV cardiac disease
• No congestive heart failure
• No myocardial infarction within the past 2 months

Other

• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception during and for up to 3 months after study participation
• No uncontrolled diabetes
• No uncontrolled active infection
• No HIV infection
• No psychological, familial, sociological, or geographical condition that would preclude study compliance or participation
• No other severe and/or uncontrolled medical disease
• No other malignancy within the past 5 years except adequately treated basal cell or squamous cell skin cancer or carcinoma in situ of the cervix

PRIOR CONCURRENT THERAPY:

Biologic therapy

• No other prior molecular targeted or biologic therapy
• No concurrent filgrastim (G-CSF) or sargramostim (GM-CSF) to support blood counts
• No concurrent anticancer biologic agents

Chemotherapy

• No prior chemotherapy for gastrointestinal stromal tumors
• No concurrent anticancer chemotherapy

Endocrine therapy

• Not specified

Radiotherapy

• No prior radiotherapy
• No concurrent anticancer radiotherapy

Surgery

• See Disease Characteristics
• Prior non-curative surgery allowed (e.g., surgery with main diagnostic intent or emergency surgery with symptomatic intent)

Other

• No prior imatinib mesylate
• No prior randomization to this study

• No concurrent therapeutic anticoagulation with coumarin derivatives

  • Concurrent therapeutic low-molecular weight heparin or mini-dose coumarin derivatives (equivalent to oral warfarin 1 mg/day) allowed for prophylaxis of central venous catheter thrombosis
• No other concurrent antitumoral therapy
• No other concurrent anticancer agents
• No other concurrent investigational drugs

Contacts and Locations

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Sponsors and Collaborators

European Organisation for Research and Treatment of Cancer - EORTC

Italian Sarcoma Group

UNICANCER

Grupo Espanol de Investigacion en Sarcomas

Investigators

Study Chair:	Paolo G. Casali, MD	Fondazione IRCCS Istituto Nazionale dei Tumori, Milano
Study Chair:	Axel Le Cesne, MD	Gustave Roussy, Cancer Campus, Grand Paris
Study Chair:	Andres Poveda, MD	Instituto Valenciano De Oncologia

More Information

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Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Casali PG, Le Cesne A, Poveda Velasco A, Kotasek D, Rutkowski P, Hohenberger P, Fumagalli E, Judson IR, Italiano A, Gelderblom H, Adenis A, Hartmann JT, Duffaud F, Goldstein D, Broto JM, Gronchi A, Dei Tos AP, Marréaud S, van der Graaf WT, Zalcberg JR, Litière S, Blay JY. Time to Definitive Failure to the First Tyrosine Kinase Inhibitor in Localized GI Stromal Tumors Treated With Imatinib As an Adjuvant: A European Organisation for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group Intergroup Randomized Trial in Collaboration With the Australasian Gastro-Intestinal Trials Group, UNICANCER, French Sarcoma Group, Italian Sarcoma Group, and Spanish Group for Research on Sarcomas. J Clin Oncol. 2015 Dec 20;33(36):4276-83. doi: 10.1200/JCO.2015.62.4304. Epub 2015 Nov 16.

Responsible Party:	European Organisation for Research and Treatment of Cancer - EORTC
ClinicalTrials.gov Identifier:	NCT00103168 History of Changes
Other Study ID Numbers:	EORTC-62024; EORTC-62024; ISG-62024; FRE-FNCLCC-EORTC-62024; GEIS-EORTC-62024; 2004-001810-16 ( EudraCT Number )
First Posted:	February 8, 2005
Last Update Posted:	July 9, 2018
Last Verified:	July 2018

Keywords provided by European Organisation for Research and Treatment of Cancer - EORTC:

gastrointestinal stromal tumor

Additional relevant MeSH terms:

Gastrointestinal Stromal Tumors; Neoplasms, Connective Tissue; Neoplasms, Connective and Soft Tissue; Neoplasms by Histologic Type; Neoplasms; Gastrointestinal Neoplasms; Digestive System Neoplasms	Digestive System Diseases; Gastrointestinal Diseases; Imatinib Mesylate; Antineoplastic Agents; Protein Kinase Inhibitors; Enzyme Inhibitors; Molecular Mechanisms of Pharmacological Action